肝硬化食管胃静脉曲张破裂出血行规律内镜下治疗的临床价值  

Clinical value of regular endoscopic treatment for esophageal and gastric variceal bleeding in patients with liver cirrhosis

作　　者：张娜 彭春艳[2] 张峰[2] 张明[2] 诸葛宇征 Zhang Na;Peng Chunyan;Zhang Feng;Zhang Ming;Zhuge Yuzheng(Southeast University Medical School,Nanjing 210009,China;Department of Gastroenterology,Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]东南大学医学院,南京210009 [2]南京鼓楼医院消化内科,南京210008

出　　处：《中华消化内镜杂志》2022年第5期384-387,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价肝硬化食管胃静脉曲张破裂出血(esophagogastric variceal bleeding,EGVB)患者行规律内镜下治疗的临床价值。方法2015年1月-2018年1月,在南京鼓楼医院行内镜下止血治疗的305例肝硬化EGVB病例纳入回顾性队列研究,按是否规律内镜下治疗分成2组,即规律内镜治疗组(n=145)和未规律内镜治疗组(n=160),主要观察指标为再出血率,次要观察指标为随访时间、再出血间隔时间和再出血死亡率。结果2组患者在性别构成、平均年龄、病因构成.病因是否控制、肝脏储备功能、是否服用非选择性β受体阻滞剂等方面差异均无统计学意义(P>0.05),基线资料具有可比性。再出血率规律内镜治疗组为11.7%(17/145),未规律内镜治疗组为4.9%(67/160)(Х^(2)=38.74,P<0.001);随访时间规律内镜治疗组为(28.14±11.11)个月,未规律内镜治疗组为(21.10±12.37)个月(t=5.21,P<0.001);再出血间隔时间规律内镜治疗组为12.0(6.0,23.0)个月,未规律内镜治疗组为1.0(1.0,6.0)个月(U=164.00,P<0.001);再出血死亡率规律内镜治疗组为1.4%(2/145),未规律内镜治疗组为10.6%(17/160)(Х^(2)=11.13,P=0.001)。结论相较于未行规律内镜下治疗者,肝硬化EGVB患者行规律内镜下治疗更具临床意义,可显著降低再出血率、延长再出血时间间隔、减少再出血死亡率。Objective To evaluate the regular endoscopic therapy for esophageal and gastric variceal bleeding(EGVB)in patients with liver cirrhosis.Methods A total of 305 patients of EGVB with liver cirrhosis who received endoscopic hemostasis in Nanjing Drum Tower Hospital between January 2015 and January 2018 were included in the retrospective cohort study.Patients were divided into the regular endoscopic treatment group(n=145)and the irregular endoscopic treatment group(ra=160).The primary outcome measure was rebleeding rate,and the secondary outcome measures were follow-up time,rebleeding interval and rebleeding mortality.Results There were no significant differences between the two groups in terms of gender composition,average age,etiology composition,the cause of disease under or out of control,liver reserve function,or administration of non-selective β-blockers(P>0.05),and the baseline data were comparable.The rebleeding rate was 11.7%(17/145)in the regular endoscopic treatment group and 41.9%(67/160)in the irregular endoscopic treatment group(Х^(2)=38.74,P<O.OO1).The follow-up time,rebleeding intervals and mortalies of rebleeding in the regular endoscopic treatment group and the irregular endoscopic treatment group were 28.14±11.11 months and 21.10±12.37 months(t=5.21,P<O.OO1),12.0(6.0,23.0)months and 1.0(1.0,6.0)months(17=164.00,P<O.OO1),and 1.4%(2/145)and 10.6%(17/160)(^=11.13,P=0.001),respectively.Conclusion Compared with irregular endoscopic treatment,regular endoscopic treatment of EGVB in patients with liver cirrhosis has more clinical significance,which can significantly reduce the rebleeding rate,prolong the rebleeding interval,and reduce the mortality of rebleeding.

关 键 词：食管和胃静脉曲张 内镜下静脉曲张套扎术 内镜下硬化剂注射术 规律治疗 再出血 

分 类 号：R575.2[医药卫生—消化系统]